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Now that I'm in grad school (in addition to active practice) I find myself asking better questions. Like: "Why don't all headache patients get better under my care?" And, "How can I get a greater proportion of headache patients better?" As regards headache, one way is through accurate diagnosis of the origin of your headache.

Let me characterize the type (or "flavor") of headache that Dr. Jon and I fix, daily, here at The Center for Spine, Sport & Physical Medicine. It's called a "Cervicogenic" Headache, and here are the distinguishing features:

- Always starts in the neck. This headache spreads up to the head from the neck. Always.

- Almost always on one side only. A cervicogenic headache that starts on the RIGHT side of the neck will spread to the RIGHT side of the head. There is never crossover. (Migraines, on the other hand, can start in the neck but spread to the whole head, or spread to the OPPOSITE side of the head.)

- A cervicogenic headache is always associated with restricted joint movement in the facet joints of the upper neck (occiput/C1 through C4). This is where skill in diagnosis comes in. Those clinicians (chiropractors, physical therapists, MDs or others) who are in a big hurry or who have poor manual/palpation skills will give you neck pain when they feel your neck just because they are heavy-handed. If they make your neck hurt by their examination, they might conclude you have a cervicogenic headache when you don't. Further, many providers (regardless of degree) just really aren't very skilled in this area. Sad, but true. There IS a difference. Dr. Seeman and I consider this skill to be very, very important -- and primary to our practice of chiropractic for our headache patients.

- A cervicogenic headache will always be associated with restricted range of motion. In my 30 years of experience, this is most notable in side bending and/or in rotation, and is less noticed in forward flexion and in extension.

What's the Difference Between Cervicogenic Headache and Other Headaches?

Great question! Almost all headache also involve neck pain, so here's the difference. A cervicogenic headache ALWAYS starts in the neck. Other types of headache can start in the head or start in the neck. So if your headache starts in the head with no neck pain or tension, you can be sure it is NOT a cervicogenic headache.

Also, non-cervicogenic headaches might alternate from left side to right side, back of head to forehead (involving both sides), etc. It won't always consistently involve pain on the same side of the neck / same side of the head. This is true for tension headaches and migraine headache.

Non-cervicogenic headaches are not associated with restricted joint movement in the upper cervical facet joints.

Non-cervicogenic headaches are not associated with restricted range of motion.

How Can I Know for Sure Whether My Headache Will Respond to Chiropractic Care?

Make sure you choose a headache doctor who has excellent skills in palpating for restricted joint movement in the joints of your upper neck. Also, make sure your headache doctor performs a full neck range of motion examination. Only in this way can a cervicogenic headache be diagnosed accurately.

A Note About Post-Concussion Headaches

Think about what happens with most concussions (for example, from a car accident or from participation in sports). Often concussions are associated with a blow to the head. If you sustain a blow to the head, what are the chances that you might also sustain significant trauma to your neck? And that is exactly my point. It is possible that your post-concussion headache could be entirely from your brain, OR FROM YOUR NECK, or BOTH. Often post-concussion headache carries a component of cervicogenic headache owing to the trauma to the neck! In all cases of concussion we advise that you have a careful neck examination.

Thanks for reading!

~ Dr. Joel Carmichael, DC, DACBSP

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Dr. Joel Carmichael, DC attended Logan College of Chiropractic in St. Louis, graduating valedictorian magna cum laude in 1985. He became the second chiropractor in the United States to complete a one-year hospital residency in chiropractic family practice at Lindell Hospital with an emphasis in orthopedics. He attended grand rounds in orthopedics and rheumatology at Barnes Hospital/Washington University School of Medicine—ranked in 2007 as the 4th leading medical school in the country.

Dr. Jon Seeman graduated from Western States Chiropractic College in Portland, Oregon in 2006. He completed an internship in Beaverton, Oregon with Dr. Ted Forcum who, with Dr. Carmichael, is a top Olympic sports chiropractor. Dr. Seeman participated in treatment of amateur, elite and professional athletes from various sports. Dr. Seeman was trained in various sport injury protocols and procedures that have been proven to help with a faster recovery and enhance overall performance.